Prevalence of Exceeding Maximum Daily Dose of Acetaminophen, and Seasonal Variations in Cold-Flu Season

Abstract

Aims

To estimate prevalence of excess intake of acetaminophen, and investigate seasonal variations therein.

Methods

Between 2011 and 2016, 14,481 US adults who used acetaminophen in the preceding 30 days were sampled from national online panels and completed a detailed online daily diary of acetaminophen medication use for 7 days. Respondents were not told the study concerned acetaminophen. Cold/flu season (CFS), identified using Google© Trends data, was contrasted to off-season in symptoms, use of acetaminophen medications, and consumption exceeding 4 grams (the recommended daily maximum).

Results

Overall, 6.3% [95% CI: 6.0%-6.6%] of users exceeded 4 grams on at least one day; 3.7% [3.5%-3.9%] of usage days exceeded 4 grams. Cold/flu symptoms were more likely to be experienced and treated with acetaminophen in CFS than off-season. Acetaminophen users were more likely to exceed 4 grams during CFS (6.5% vs 5.3%; OR= 1.24, 1.04-1.48); days exceeding 4 grams also increased (3.9% vs 2.8%; OR= 1.37, 1.11-1.69). This was not due to differences in characteristics of individuals using acetaminophen in CFS, but primarily to increased use of over-the-counter (OTC) combination medications designed to treat upper respiratory cold/flu symptoms (33.2% of usage days in CFS vs 24.8% in off-season; OR=1.6, 1.5-1.7). When such medications were omitted, there was no statistically significant seasonal variation in exceeding 4 grams.

Conclusions

Acetaminophen use and over-dosing increases in CFS, primarily due to increased use of OTC combinations treating upper respiratory cold/flu symptoms. Pharmacists should warn users to follow labeled dosing directions, especially during CFS.

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